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Possible cecum removal
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Possible cecum removal

  
I have a long history of both hyperplastic and adenomatous polyps (all benign so far).  I am a 73 year old male and otherwise in good health.  Four years ago I had 3 hyperplastic polyps removed from the sigmoid area.   I recently had another colonoscopy done and the surgeon found two benign polyps in the sigmoid area again, one hyperplastic and one adenomatous.  They were removed without inicident.  However he also found what he described as a polyp in the cecum that was too large to be safely removed by endoscope.  He told me that the cecum polyp was wide and without a stalk (sessile?) and the only way to have it removed is to remove the cecum and reconnect the small intestine to the remaining colon.  He also said that if I were older and in frail health he would recommend doing nothing except keep an eye on the polyp's development. He told me that although the plolyp is benign the chances of it turning to cancer increase as it grows.  He also said there is no hurry, but recommends removing it through laporoscopic surgery.  I also remember seeing the words "suggestive of adenoma" on the resulting paperwork.  Here are my questions:  

1.  Should I have that polyp removed, or should I "keep an eye on it?"

2.  If it is removed is it necessary to also remove the Ileocecal valve.  I get the impression  that the entire cecum, including the Ileocecal valve will be removed.  I remember seeing it on the monitor during the colonoscopy and it appears to be right at the end of the colon near the appendix.

3. If the Ileocecal valve is removed what are the long term health implications and prognosis?  Will I have to continually take antibiotics or go on a strict diet?

4. Why wasn't this polyp discovered during that colonoscopy four years ago, by the same doctor?  Is it easy to miss?

5. What else should I be concerned about?

6.  "suggestive of adenoma" sounds kind of "maybe or maybe not."  What does it mean exactly?


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15 Comments Post a Comment
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Avatar_m_tn
1. You can't keep an eye on it :) , only doctor with colonoscope can. Often, when a benign polyp turns into a cancer, there is no symptoms at all.
2. Removing ileocecal valve or not, this is a question for surgeon. From your description, probably yes. But if it's only a benign adenoma, maybe not necessary.
3. Only consequence is - possible small intestinal bacterial overgrowth. This is not necessary to happen, and when it does, it is treated with antibiotics, but not permanently, only to cure each separate overgrowth, if it happens. No strict diet. Bacteria thrive mostly on sugars, so you'll be maybe recommended to avoid simple sugars (sweets, fruit juices..), but again, only, if you'll have bacterial overgrowth.  
4. 4 years is enough for a polyp to grow from zero to present size.
5. Concern: polyp will need to go out soon or later, now its your desicion - listening of its growth all the time or postpone the procedure for ? time. That polyp may cause obstruction or ileocecal valve incompetence by itself.
6. Adenoma may be "suggestive" when looked at it with an naked eye during colonoscopy, but after histological evaluation it should be exactly determined.
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Avatar_f_tn
If the ileocecal valve is removed it will result in an effect called 'dumping.' In other words, the compartmentalization of the last part of the small intestine will be lost and as the material moves into the end of the termal ileum, it's remaining in that portion of the GI tract will be compromised. The fecal material exiting from the terminal portion of the ileum is extremely liquidy. The valve allows for sequential/timed delivery of that material into the ascending colon. Since one of the functions of the colon is to 'recycle' fluids - by recovery - some of that fluid may not be recovered and the contents of the large intestine may remain more liquid if a portion of both the terminal ileum and ascending colon are removed during the surgery. This may result in more frequent output of stool whose contents may be of a more liquid form. Some find they're able to modify their diet to decrease the unwanted side-effects. You may want to discuss this with your doctor.
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Avatar_m_tn
I just want to thank you for the information your provided.  It gives me something to work with.  Prior to this forum, I was lost.  

I am very greatful that the growth was not cancer, thank God for that.  Again thanks

Rick
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Avatar_m_tn
Your description of the ileocecal valve mechanics was very helpful to me, thank you for the information and thank God for this forum. With the information you provided I am now at least able to understand what is going on.   Thanks again.

Rick
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Avatar_m_tn
I was just told that I will have to take 3 grams of Neomycin and 3 grams of Erythromycin
the day before surgery (divided doses 1gm each).  Since Neomycin has a reputation for being toxic I was wondering if anyone knows of a safer drug to use.   ?

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Avatar_m_tn
One single dose or one day of Neomycin should not be toxic, I guess. To be sure, ask your surgeon, if any patient had ear or kidney damage from it; he has no reason to lie you about it. Ask, if you can simply skip these oral antibiotics, since one study showed, that there oral antibiotic prophylaxis had no benefit in prevention of endocarditis or other postoperative infections. Erythromycin in general is pretty safe antibiotic.
http://www.medscape.com/viewarticle/457827

One alternative is metronidazole, but this one again is toxic for ear (rarely) and may cause serious nausea.
http://www.fpnotebook.com/SUR135.htm

Be aware that you'll also get intravenous antibiotics during the actual procedure, so you might ask about which ones will be used.

Surgeon has the last word. Usually each clinic has its own doctrine about using these antibiotics. It's hard to be smarter than an experien
ced surgeon.
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Avatar_n_tn
Rick I am a 40 year old female that had my ileocecal valve removed 4 years ago and while it is a pain in my BUTT (litterly) .. I feel much better then i did b4.  Iv noticed that eating fried foods really upsets my tummy and that for some reason Chicken really digest well. ( sometimes ever fried chic,, if not to greesy) .. and the fluid thing really does a number on me.. if i drink alot while i eat its horriable .. so i have slowed down on that.. id say all in all it is much better than what could have happen... let me know if you want to chat...
Jean
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Avatar_n_tn
rick there is no easy way of answering this question for you..me i had colon polyps also my was full of ""CANCER"" if the dr. (ob-gyn) had not told me to get a test done i would not be here with my family i was 32 yrs.. at the time,,the  gastro.dr. said i was the youngest that he has ever had that had polyps and full of cancer..i wasn't saved then i guess what i'm trying to say is put this situation in ""JESUS'""hands trust in gods son you know ROMANS 8:28 says ""ALL THINGS WORK TOGETHER FOR THE GOOD TO THOSE WHO LOVE THE LORD THAT ARE CALLED ACCORDING TO HIS PURPOSE""so maybe there is a testimony in this for you to share with people..just keep giving ""JESUS"" the praise and glory and i ""PROMISE"" all these things won't seem to matter as much!! just thank him every morn when you awake...you know people  tend to think that they have worse troubles than others..but some people don't tend to tell all the problems that they have...i will be ""PRAYING"" for you that  god will give you the wisdom to help you make that right decision and the strenght to do so... "LOVE IN JESUS CHRIST" tammy
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Avatar_m_tn
Hi Jean, thank you for responding.  It sounds like you have adjusted well and I hope you continue to do well.  I will be having the surgery later this month.  When I asked my surgeon about this issue he told me that I should not notice any difference.  He also said that I did not really need the ileocecal valve.  Anyway this is all new to me so I will trust in God and the surgeon for a good outcome.  I also asked the hospitals pre-admission testing professionals how other people who have had this surgery make out and they replied that others have come through it without problems.  I was told that the body is good at adjusting to this new "configuration."   I will keep you informed.  Again, thank you so much for sharing your experience.

Rick
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Avatar_m_tn
Hi Tammy, thank you so much for responding.  It looks like JESUS is working in your life and I know HE will see us through anything.  I too was saved about 3 years ago and I thank the Lord every day for all the positive things in my life.  I have full faith in him and that gives my quite a bit of comfort.  As I mentioned earlier I am having the surgey done later this month and knowing that JESUS is with me helps a lot. Thank you for your prayers.  This is interesting:  I had a colonoscopy done a little over four years ago.  The Doctor said I would not need another one until five years have passed.  Well about 4 years and 2 months later I had a very strong feeling that I should have another colonoscopy done. It was strange but that feeling would not go away.  I know now that feeling was from the Holy Spirit and I thank God that He gave me that warning.  The Doctor found a "sessile" polyp about 2 cm wide that could not be removed during the colonscopy.  He took biopsies and they turned out to be negative but showed the growth to be "Adenomatous."  So I am also VERY thankful for that as you can imagine.  I pray for all those that are going through much more serious problems than I and with God's will they too will experience the love and compassion of JESUS.  The glory is all His.  Thank you JESUS.
Rick

Rick
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Avatar_n_tn
I  was in the hospital for a week after the surgery... and it was general... it was exploratory so they didnt know what they would find... but i was in there so long because my bowels were not moving ... i finially talked them into taking the deloted drip out and with in two hours all that started working again... the only problem i had after was about 3 weeks later i had to go to the emergency room... i thought i was gonna die it hurt so bad and then i burped and felt all better so it was just gas... lol... i had a very large incession so that took a while to get over.. but no probs since... I also had a suction tube for almost a week and was soooo scared to let them take it out... ( if you have to have that you make sure they empty that suction bottle often if it gets full it is nooooootttttt fun... throwning up and sneezing hurts like a ... well it hurts  lol.... )this is the thing.. i had never had anything wrong with me... so i was scared of everything... turns out im  alittle tougher then i thought and know i could do it again if i had to... i really only took me about a month to get over but mentally about 6 months.. lol.. MY surgery was in june and i went skining in dec.. when i took a big fall i was scared to death and then half way down i realized that nothign was fixxing to pot out of me and i was very well healed.. as far as what they took it was small amounts of large small and the illiocecal valve.. i also had my apendix taken out it had absesed but the scar tissue had grown around it and wouldnt allow it to burst.. so that was a good thing.. and i had a cyst burst on my overy while in surgery .. i know it sounds like im makeing this up but its all true,,, the amazing part is that they did every test b4 surgery and nothing showed up... my husband wanted me to get a second opinion but i told him that if it ment i had to drink all that crappy stuff again no way.... so thats my story if theres anything i can help you with just let me know and good luck...Jean
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Avatar_m_tn
Wow!  Sounds like you had a pretty rough time of it.  Maybe because it was exploratory, I don't know.  Anyway I appreciate the information.  Like you I have never had any surgery and so I am kinda leary of the whole thing.  Thanks for tip about that suction tube bottle.  

I will post the results when the time comes.  I have been doing things lately that I probably wont be able to do for a while after surgery, like cleaning the yard, etc..
I also stocked up on some baby food just in case I can't eat normally.  I hope to be able to drive within 2 weeks or so because my wife doesn't and that could be problematic.  
Four more days until I drink that great  large container of Go litely - can't wait :-)
Thanks again...Rick
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Avatar_m_tn
I got back today at noon.  Right now the worst of it is dealing with the pain med - it helps the pain but it justs makes me so down and out I am trying to not take it at all.  

What an ordeal that was.  First of all I had to drink sixteen glasses of "go litely" to clean me out last Sunday and I darned near chocked trying to get it down. That Night I could not sleep because I was anticipating the surgery, which is my first major surgery.  My grand daughter   took me to the hospital and they herded about 10 of us in there just like I was back in the military.  I wound up on a gurney and full of "whatever" that made me almost completely blank out.  The next thing I know I am lying on my back with my right hand extended out trying to reach people in this black,blue,gray recovery room to tell them that I am hurting like hell. But no one was paying any attention to me.   I was on Morphine at that time but didn't know it, and the surgery was over.  From that time until this afternoon I was fighting extreme fatique, pain, dizziness and everything else that goes on at the same time.  No solid food, only liquids for Mon, Tues, Wed.  and was told as soon as I farted I could get some pudding.  So I struggled with my butt and as soon as I could feel the gas (I think) almost escape it would turn around and hide somewhere else.  After struggling with this for those three days the gas finally escaped.  Like a freight train.  It was 5:20 in the morning and I called the nurse station at that time.  I told them I just passed gas so put me on that pudding list.  (I found out later that a few visitors heard that, but I guess I didn't care).
Breakfast that morning still had only clear liquids, and I blew up about the pudding.  After a couple of hours it finally arrived, whew..   Later I saw the doctor and he upped the anti to solid foods and released me the next day which was today.  I have to see him next Tuesday so he can remove the staples from my wounds.  (It's amazing what one will do for pudding.)

Now I have to do some work on my photo's and video's because I can not do anything else.  My grand daughter brouoght over some home made chicken soup that was really good, so I guess I am on the mend.  I have three holes in my lower left abdomen wall and and a 7 inch gash on the right side.  The one on the right is the one that hurts.

I asked the surgeon to explain the stapling procedure to me because I can picture the colon and small intestine coming together like two wet paper cloth tubes and it would seem to be a difficult procedure.  But he said he used a machine to staple my intestines back up and it was automatic.

What he did was to punch the four holes (3 and one gash) and then insert the camera, lights, surgeon tools and whatever else through those hole to perform the operation.  They also insert a large amount of gas to extend the abdomen (like a tent) to give working room and the surgery was performed on HD TV.  I think that it is hydrogen gas that they use and that is what you finally expel, which is a signal that everything is hooked up right.  The surgery took two hours.  Any way it's behind Me now:-)

The surgeon was a bit disappointed that he could not remove that growth during the previous colonoscopy, because it was only a little tiny thing he said.  It is being examined  in more detail and a report is forthcoming.  But he feels it is still not cancer.

I am thankful that I didn't know what to expect because it would have been hard to take knowing what lay ahead.  There was no comfortable moments through the entire thing.   But, I am thankful for the hospital and staff and to this excellent surgeon.  They really worked hard trying to do the right thing. I was impressed with that part.  

(I still see that scene in the recovery room which made me feel like I was an abductee aboard a space ship, that's the only way I can describe it.)  They did manage to abduct my Cecum...

UPDATE: Saturday, Aug 30 2008

It is now two days from being released from the hospital and the first thing this morning I was wondering when I would have my first bowel movement, because that would ease my worry about getting back to some kind of normalcy.  The only thing I expelled since the surgery was gas, but after a couple of cups of coffee this morning I had two bowel movements so that made me really feel better.  I thank God for his help in all of this.  

Later today, I noticed some drainage on the larger bandage on the right side, and to me, it appeared to be yellow-greenish in color and about the size of a quarter.  I have a piece of paper the hospital gave me that says to call if there is a yellow-greenish discharge, red around the site and hot to the touch - to call the doctor.  I only had one of those - the discharge.  Anyway my anticipation and suspicious mind started working again and I called the surgeon.  He said it doesn't appear to be anything to worry about.  He asked about the color of the surrounding skin and if there was any pain.  I answered in the negative.  Thank God.  Another worry taken care of.

I feel much better today.  I am mobile and walk around the house without difficulty.  There is still some pain around the larger incision site, but it is not too bad.  All in all I really feel fine.  

I hope this information helps someone on this forum, because I know I was full of anticipation and tore the internet apart looking for answers.  

I am in deep gratitude for those that responded to me.  God bless you all
Rick
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Avatar_m_tn
YOUR ITUATION MIRRORS MINE , ALMOST EXACTLY. YOUR EXPERIENCE WAS VERY INFORMATIVE AND HAS HELPED ME, GREATLY.
THANK YOU,
JIFFYJIM
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Avatar_m_tn
I am facing surgery to remove my cecum due to a polyp that could not be removed during colonoscopy. since the function of the cecum is to remove water from the stool, I am concerned about bowl function after the surgery. Could you tell me if frequent loose stools have been a problem for you.
Sue
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